Latest Blog

Q&A with Joaquin Antonio Ramirez, Urology SHO at RLH

By Gabrielle Richardson
September 21, 2018

Hello, nice to meet you! What is your name, speciality and where do you work? Hi! My name is Dr Ramirez and I work as an SHO in Urology at the Royal London Hospital. Where is your home country? I am originally from Costa Rica. Why did you decide to relocate to the UK and what were your motivations? I came to the UK with the hopes to specialise in Surgery and to learn about minimally invasive procedures which are more common in the UK than where I come from. Relocating to the UK was very easy for me, I have been an expat for a long time and in my opinion, the UK is one of the easiest countries to relocate and find a job in, there are many people willing to help and everyone has been very welcoming since I arrived here. What are your thoughts on living in London? London can be a very hectic city to live in, as with any city it has its pros and cons, but I can assure you all that you will not be bored for a second if you decide to relocate here. The number of things to see and do is just amazing! What are your thoughts on the NHS as a system? I find it amazing how people in the UK respect and value the NHS as an institution and because of that support, doctors, can bring an amazing level of care to people for free. Do you have any advice for junior doctors who are considering specialising in Urology? I believe this is a great time to pursue Urology training in the UK, as it is a speciality that is suited for those interested in recent technological advances and research. I personally believe the most fascinating branch is urologic-oncology but there are many areas to specialise in, such as: -Sexual health -Infectious conditions The main path for a doctor who aspires to become a Urologist is to complete the MRCS exam and then apply for a Registrar post, this can either be a training or a service post – both routes can lead to you becoming a Consultant. I thoroughly enjoy working in Urology at the Royal London Hospital, it is a great speciality especially if you like video games. This is because now, everything is done through an endoscopic approach, so you are usually controlling instruments and see what you are doing via a TV screen. We recently got a surgical robot in RHL that we use for benign procedures, as a result, it has shortened the patient’s stay at the hospital and they can leave with practically no visible scars. Plus, it is really easy and fun to use compared to traditional laparoscopy. I find this minimally invasive approach very exciting and I hope every day we will be able to offer this to more people in the UK and around the world. Do you have any advice for Urology patients? I am going to split my answer into to parts, for the two patients that I have treated: A)Patients suffering from renal/ureteric stones The cause of a patient suffering from stones can vary. The most common stones are calcium oxalate and they are caused by a combination of factors including genetics, dehydration and consuming a high quantity of oxalate in your diet. Foods that are high in oxalate and ones you should avoid if you suffer from this condition include spinach, bran flakes, rhubarb, beetroot, potatoes, chips, nuts, nut butter and many others. Other types of stones can be caused by other factors such as recurrent urinary tract infections or gout, in this case, the main prevention is to treat the underlying medical condition as effectively as possible to prevent recurrence of calculi. B)Patients suffering from BPH or more commonly known as an enlarged prostate BPH stands for benign prostatic hypertrophy and it is a condition that affects up to 40% of men over the age of 65. It is an enlargement of the prostate gland that envelops the urethra making it difficult for the affected individual to pass urine, usually requiring them to depend on a urinary catheter to be able to empty their bladder. BPH is typically caused by environmental factors that are still relatively unknown however, it has been theorised that it is caused by an increased conversion of testosterone to DHT or dihydrotestosterone, which is the hormone responsible for some changes in ageing males such as male pattern baldness. Theoretically, men who produce higher levels of testosterone have a higher chance of it developing BPH and just anecdotally I can confirm that many of my patients who suffered from this condition tend to be very muscular and ‘manly’ looking men, which is something I tell my patients which never fails to get a smile out of them. It has been reported that aerobic exercise and a diet low in meat can prevent the incidence of BPH, but I believe the evidence is not yet conclusive on this matter. Currently, the best treatment available is for surgery and the most common procedure is called TURP (transurethral resection of the prostate) which involves passing a camera through the urethra and using an instrument called a resectoscope to ‘shave off’ a larger channel for the urine to pass through. This is done using an endoscopic cautery knife called a resectoscope. The surgery involves no cuts and is all done through this keyhole approach and it is currently the most effective way of treating this condition. There is a relatively high (5%) risk of causing erectile dysfunction which is why we are constantly looking for new ways to treat BDP which are safe and effective. At Royal London Hospital, where I did my Urology placement, we are studying a new technique called Uro-Lift, which is a less invasive procedure which involves ‘clipping’ the prostate with two clips that open the urethra clearing the passage. This new technique has shown promising results, but it is still in its early stages and we require more patients to undergo this procedure to confirm its superiority to the traditional TURP. Thank you for your advice, Dr Ramirez. What are your plans for the future? Eventually, I would like to go back to Costa Rica to help improve my home country with what I have learnt here. But for now, I have a lot of training ahead of me and so the UK is my current home.

The cost of running a car in the UK

By Gabrielle Richardson
September 19, 2018

After you have settled into the UK, found your way around the local area, obtained a UK driving licence, you will begin to think about purchasing a car. Buying a car can be an expensive venture, therefore, in today’s post, we provide you with all the costs involved in running a car. To drive a car on public roads there are certain requirements you must meet by law: Car Insurance The amount you pay for your car insurance is called a premium. Insurance companies will take various details from you to work out what your monthly or yearly premium will be. This includes personal details (such as age and postcode), the cars details, the level of cover you are looking for, previous car insurance claims etc. This information will allow the insurance broker to calculate your premium based upon the provided information. The best way to get cheaper car insurance is to use comparison sites to find the best deal. Once you have a couple of good quotes, you might want to call an insurance broker and ask them to beat it (it’s free, they will do all the work and then call you back).  We also advise for you to pay your premium all at once, rather than monthly instalments as you will have to pay interest on instalments.   Useful Car Insurance Comparison Websites: Compare the Market Go Compare Car Tax Car tax is also referred to as road tax and it must be paid on all registered vehicles that are kept or driven on public roads. The price of road tax can vary depending on how environmentally friendly your car is. When you purchase your road tax online, it will be automatically transferred with the vehicle. It is important to remember that you must tax your car before you use it. Choosing the right car can make a big difference to your tax costs, as choosing a low-tax car could mean it holds its value better as more people will want to buy it. If you have already bought a car and you want to find out how much its tax is going to cost, please click here. Please click here for a list of tax free cars. MOT Testing An MOT is a yearly test for all cars over three years old. The vehicle, by UK law, must pass its MOT to ensure it is safe and roadworthy. The maximum price for an MOT costs £54.85, however, some garages offer cheaper prices to guarantee they get the repair business too. Other costs involved in running a car: Fuelling the car The average price of a litre of fuel in the UK is around £1.29 (September 2018) for petrol and £1.33 for diesel, however, this price will fluctuate from street to street and town to town. To calculate how much it will cost for you to fuel your car each month please click here. Tips for reducing your fuel costs: Careful driving: gentle acceleration and not driving quickly all the time will reduce the amount of fuel that you use Efficiency: The bigger your car's engine is the more fuel it will use in general Shopping: If you buy your fuel from the same petrol provider then they are likely to offer a loyalty card, which will allow you to build up your rewards points to spend on other shopping Travel for your fuel: Buying it from a supermarket petrol station over a motorway/local stations – the prices can be considerably lower Servicing and Maintenance Costs Upon considering how much it will cost to run a car, it is important you do not forget about maintenance fees of the car. The RAC, a UK motor car service states that it costs around £472 a year to maintain a used car. This fee includes an MOT, a service and any repairs needed. However, please note that if you buy a new car it is likely that you may not need any repairs at all. It is important to service your car regularly, as it will help maintain its value and reduce costs in the long-term. To read our blog: How to get a UK driving licence please click here. References (2018). Car insurance for young drivers – the key facts. [online] Available at: https://www.moneyadviceservi

Your NHS Salary

By Gabrielle Richardson
September 17, 2018

Every week we see many doctors begin their career within the NHS, joining hospitals all over the UK. In today’s post, we provide you with our top tips on how to manage your finances after relocating to the UK. If you have any questions regarding any of our tips, please email and we will be happy to advise you. Disclaimer – we are not a financial advisory firm and the tips below our just our tips from experience with working with IMGs. 1. Work out how much you will get on your first payday Knowing how much to expect in your monthly salary payment is essential. This will help you plan your monthly outgoings, such as rent, council tax, food – this will allow you to know what you can spend on recreational activities and what you can afford to save for the future. Please note that there are various apps available on smart phones that allow you to calculate your monthly salary – try searching “Salary Calculator” in your app store. There are also apps to guide you on your expenditure and it calculates how much you can afford to save each month. Try this link for a full list. 2. Understand the UK tax system Before you receive your first paycheck it is important to understand how UK income tax works.        How does it work? Each UK citizen has a “personal allowance” which denotes the amount we can earn without paying any income tax. If you earn more than your personal allowance, then you pay tax at the applicable rate on all earnings above the personal allowance, but the allo wance remains untaxed. What is my personal allowance? Earning bracket Personal allowance Under £100,000 £11,850 £100,000 to £123,700 Decreased from £11,850 by £1 for every £2 you earn, until it reaches £0 Over £123,700 £0 What income tax band am I in? Once you know your personal allowance, anything extra earned will be subject to income tax. For 2018/19 tax year, if you live in England, Wales or Northern Ireland, there are three marginal income tax bands – at the 20% basic rate, the 40% higher rate and the 45% additional rate bracket (remember your personal allowance starts to shrink once earnings hit £100,000). If you live in Scotland, there are five marginal income tax bands from the 2018/19 tax year - the starter rate of 19%, the 20% basic rate, the 21% intermediate rate, the 41% higher rate, and the 46% additional rate. Earnings (England, Wales or NI) 2018/2019 Rate Under your personal allowance For most, £11,850 No income tax payable Between PA and PA+£34,500 (basic rate) For most, £11,850 to £46,350 20% Between PA+£34,500 and £150,000 (higher rate) For most, £46,350 to £150,000 40% Over £150,000 (additional rate) 45% Example monthly take home for a doctor’s salary Level Basic Salary Basic Salary after tax Monthly take home FY1 £26,614 £21,480 £1,790 FY2 £30,805 £24,330 £2,028 Specialist Training £36,461 £28,176 £2,348 Speciality Doctors £37,923 £29,170 £2,431 Consultants £76,761 £52,541 £4,378 GP’s £56,525 £40,804 £3,400 NB: Basic salary does not include any uplifts, banding or additional PA’s. To work out your monthly take home for your specific salary please visit this site. You should also note that there is a further opportunity to increase your salary either through Bank Staff work or agency Locum work. Please visit our article on this matter for further information. National Insurance Please note that you will also have to pay National Insurance along with your tax.  How much will I pay? Your pay Class 1 National Insurance rate £162 to £892 a week (£702 to £3,863 a month) 12% Over £892 a week (£3,863 a month) 2% How do I pay? Your National Insurance contribution will be taken from your wages before you are paid and your payslip will show your contributions. NHS Pension You will also be entitled to contribute to your pension via the NHS Pension Scheme. Within this scheme both you and your employer will contibute to your pension at different tiers depending on your pay.  How much will I contribute? Tier  Pensionable Pay (whole-time equivalent) Contribution Rate from  2015/16 to 2018/19  1  Up to £15,431.99   5.0%  2  £15,432.00 to £21,477.99  5.6% 3    £21,478.00 to £26,823.99   7.1%  4  £26,824.00 to £47,845.99  9.3%  5  £47,846.00 to £70,630.99  12.5% 6   £70,631.00 to £111,376.99   13.5% 7   £111,377.00 and over   14.5% 3. Boost your income There are two ways to boost your income once you have started your new position. NHS staff bank – each Trust has an NHS staff bank that contracts healthcare professionals to take on extra shifts at the hospital. This option allows you to pick up extra shifts within your own hospital, whenever it is convenient for you. Please note, if you are on a Tier 2 visa – there will be no restrictions on the number of bank shifts you can take up. You will be paid monthly, along with your salary for any additional bank shifts that you cover. Agency locum work – alternatively, you may choose to take up temporary work via a medical recruitment agency that provides locum work for doctors. The agency will work with various hospitals across the UK and they will help you find temporary work. Agency locum work offers a higher rate of pay compared to bank staff rates, however, on a Tier 2 visa you are limited to working up to 20 hours per week and it is likely you will have to travel to another hospital. 4. Plan your career progression – medical exams are expensive so make sure you factor these fees in Junior doctors face a number of expenses at the beginning stages of their careers. If you are a junior doctor who plans to specialise then you will need full Royal College Membership. The prices vary depending on the Royal College, so it is important that you factor in the cost of the exam fees as they are essential for your career progression. 5. Don’t forget other costs The process of relocating to the UK can be very costly, from paying for PLAB, IELTS, GMC Registration, your visa application, flights and airport transfers – but often, doctors forget about costs they will incur after they have started their position. For further information on how much it costs to relocate to the UK please visit our blog. These fees include revalidating your GMC licence, British Medical Association fees and your medical indemnity cover fees. Thank you for reading our post. If you are an IMG who is interested in relocating to the UK and working within the NHS please register your CV on our website and we will be in touch about available positions. Join our Facebook Group IMG Advisor – get frequent access to relocation blogs, the opportunity to ask questions and receive professional advice and the chance to meet other IMGs!

Who will I be working with?

By Gabrielle Richardson
September 14, 2018

When you join the NHS the people you will be working most closely with will be the other doctors in your team also known as “firm”. This will typically include: Your Consultant (most senior member of the team) Senior or Specialist Registrar (in training) Foundation Programme trainee (within the first two years after qualification) Other doctors you may come into contact with include: Staff grades (a non-training grade doctor who is typically very experienced) Clinical fellows (a trainee grade doctor undertaking research) Who will be in my multi-disciplinary team? In order for patients to receive the best possible clinical care, several healthcare professionals will be involved. This is what is known as a multi-disciplinary team. These include: Nurses – who will provide practical direct care for patients and often will provide you, as a doctor, with direct support on the wards and in clinics. The nurses are likely to have worked in the department for a long time and can provide you with invaluable advice – please do not be afraid to ask them questions. Midwives – work within the maternity and can deliver low-risk patients. They have limited prescribing abilities. Pharmacists – provide essential advice on which medications to prescribe and dispense drugs. Every hospital prescription is reviewed by them and you can contact them directly for advice when prescribing. Phlebotomists – most hospitals employ phlebotomists to take blood from patients, typically in the morning, so that results are available in the afternoon. Remember to make sure request forms are put out early in the day if you would like the phlebotomist to take blood from your patients as if you miss their ward round, you will have to take the blood yourself. Physiotherapists – assess patient mobility and may provide specialist input into care e.g. for patients with chest infections. Come and join our Facebook Group IMG Advisor.  Here, you will have access to frequent blog posts, the opportunity to ask questions regarding relocating to the UK and working within the NHS and the chance to meet other IMGs! References (2018). BMA - Life and work in the UK. [online] Available at: [Accessed 7 Sep. 2018].

The CESR Application Process

By Gabrielle Richardson
September 12, 2018

If you are an international doctor who would like to become a Consultant within the NHS, you will need to apply for CESR. CESR stands for Certificate of Eligibility for Specialist Registration. The process can take over six months and you will need to prepare various pieces of evidence to support your application. This guide will help you prepare your application, give tips on how to successfully apply and inform you of the GMC’s recent change to the CESR application process. Please read our article A guide to CESR for more in-depth information on how CESR can be advantageous to your career. In this article, we provide you with details on how to organise and submit your evidence, qualifications that need to be verified, and changes to the CESR application process. How do I organise my evidence? The GMC is able to deal with your application more quickly if you ensure that you only upload evidence that is directly relevant. They typically expect to see between 800 and 1,000 pages of evidence. For example, evidence over five years old will be given less weight than more recent evidence, so you may not need to include it. Tips – your evidence should be structured so that the GMC can assess it properly. The GMC provides an application divider pack to help arrange and present your evidence correctly. You must follow the structure of the dividers when ordering your evidence. GMC Guidance: Do not bind or staple your documents A4, A3 and A5 document sizes are permitted Double-sided documents are permitted Do not submit books or leaflets, you must scan the relevant pages and submit Do not submit your evidence in folders or plastic wallets Once you have listed your evidence within your online application, you should print your evidence checklist, which will include all of the details you have listed. The GMC advises you to use this checklist as the first page of your bundle of evidence and tick the relevant box to show that you have included each item in your bundle. How do I submit my evidence? You must ensure that you have all the pro-formas from your verifiers to accompany your evidence before you send this to us Your pro-formas must be submitted on the top of your evidence bundle and if your pro-formas are not at the top, your application may be delayed Remember to provide copies of your evidence and not the original documents How do I verify my evidence? Only certain pieces of evidence must be verified: Evidence showing registration with overseas medical regulators Qualifications gained outside the UK Who will authenticate this evidence for me? A solicitor The awarding body Evidence that does not need to be verified: Your CV Feedback Continuing professional development (CPD) certificates, courses relevant to the curriculum, evidence of attendance at teaching or appraisal courses Publications (those available in the public domain) Reflective notes or diaries Honours, prizes, awards or discretionary points Please note, you must still provide copies of the above evidence. Changes made to the CESR application process On 6th November 2018, the online application system for CESR, CEGPR and Review applications is changing. As a result of feedback from a survey, the GMC will not require applications to be submitted electronically – this will make the application process easier and less burdensome for doctors. Advantages to the change: Quicker and cheaper for you as you will not need to print and post large numbers of documents You will be able to use the online application like a portfolio to gather your evidence The application process will be quicker as there will be no delays Please note that you will still be able to submit hard-copied evidence, you will just have to inform the GMC on your online application. References (2018). CESR CEGPR application process. [online] Available at: [Accessed 7 Sep. 2018].

World Suicide Prevention Day

By Gabrielle Richardson
September 10, 2018

World Suicide Prevention Day is held every year on the 10th of September. It is an annual awareness-raising event organised by the International Association for Suicide Prevention (IASP) and the World Health Organisation (WHO). Why is Suicide Prevention Day important? The WHO published that over 800,000 people take their lives each year across the world. In the UK and the Republic of Ireland, more than 6,000 people die by suicide a year – an average of 18 a day. Therefore, it is important to reach out to people who are going through a difficult time as it can often save their life. Feeling suicidal is a result of a person feeling low, worthless and think that no-one cares for them. So, small things such as hearing from a friend or family member, being listened to or being told that ‘it is okay to talk’, either to a friend or a healthcare professional. It is important to remember that doctors are also at an incredibly high risk for mental health. Between 2011 and 2015, 430 healthcare professionals within the UK took their own lives. The NHS Practitioner Health Programme (PHP), is the only confidential service that offers doctors a range of assessments, treatment and case-management for all mental health problems. So, if you are a doctor who believes a colleague needs support please keep reading to find out ways you can help them. What are the signs of someone feeling suicidal? Talking about feeling hopeless or having no reason to live Talking about great guilt or shame Talking about feeling trapped or there are no solutions Feeling unbearable pain (emotional and physical) Talking about being a burden to others Using alcohol or drugs more often Risk Factors of Suicide Suicide does not discriminate against the type of person you are. People of all genders, ages and ethnicities can be at risk. Suicidal behaviour is very complex and there is no single cause. Various factors can cause someone to make a suicide attempt but people most at risk tend to share certain characteristics including and not limiting: Depression or other mental disorders Substance abuse disorder Chronic pain A prior suicide attempt Family violence, including physical or sexual Being exposed to others’ suicidal behaviour, such as that of family members or peers You should note that suicidal thoughts are not a normal response to stress. Suicidal thoughts or actions are a sign of extreme distress, not a harmless bid for attention and should not be ignored. Action steps to helping someone who is suffering from severe emotional pain: Be there – Listen carefully and learn what the person is thinking and feeling if they reveal that they are feeling suicidal talking about it with them will reduce their chances of going through with it. Keep them safe – Reducing a person’s access to highly dangerous items or places is an important part of suicide prevention Encouraging them to talk – Try and encourage them to call a helpline or contact someone the person might turn to for support, for example, a particular friend, family member or religious figure Encourage positive lifestyle changes – This includes a healthy diet, plenty of sleep, getting out into the sun or nature for at least 30 minutes each day. Exercise is fundamental to mental health as it releases endorphins, relieves stress and promotes emotional well-being. Remember – tomorrow needs you because you matter to someone who loves you. Please note that this article is just a guide, if you are someone else you know is feeling suicidal please contact a professional help service. NHS Choices – Suicide Samaritans Mind References (2018). NIMH » Suicide Prevention. [online] Available at: [Accessed 7 Sep. 2018].

Continuity of care - tips for Junior Doctors

By Gabrielle Richardson
September 07, 2018

Continuity of care for patients is fundamental because going into hospital can be an overwhelming experience - you want reassurance that the doctors and nurses know your name, can explain what is happening and there is “someone in charge” to answer your questions and worries. Patients can often be moved between different wards, sometimes in the middle of the night and usually without informing the patient or carers in advance. Poor communication between staff and inadequate handovers across shifts result in patient details and vital information being lost, forcing patients and carers to repeat the same information to numerous people. Doctors are therefore expected to have thorough knowledge of each patient’s inpatient journey, to ensure that every medical professional who wishes to follow the patient up has made arrangements to do so. Therefore, in today’s post we provide you with some tips on successfully executing excellent continuity of care. Tips Ensure the patient and their carers understand the follow up plan. This will reduce their anxiety, empower the patient and their partners to be champions in their own health care and increase their likelihood of attending appointments. Provide accurate and comprehensive information in discharge summaries. This is a fundamental component of continuity of care that helps to ensure that the patient’s GP is aware of new diagnoses and any changes to medications. Liaise with the specialties planning to follow-up a patient to ensure appointments are made. Communicate with each member of the multi-disciplinary team to ensure timely discharge. This is especially important for junior doctors, as they will be the primary member of the medical team who is most commonly on the ward, a junior doctor is in the perfect position to co-ordinate between the different levels of professionals involved. If you are an IMG who is interested in relocating to the UK and working within the NHS send your CV to and we will be in touch. Join our Facebook Group IMG Advisor – here you will have access to frequent blog posts on relocating to the UK and working within the NHS, the opportunity to ask questions and receive professional guidance and the chance to meet other IMGs. References Medical professionalism and regulation in the UK. (2018). Good continuity of care: four top tips for junior doctors. [online] Available at: [Accessed 5 Sep. 2018].

Everything you need to know about verifying your medical qualifications

By Gabrielle Richardson
September 05, 2018

Everything you need to know about verifying your medical qualifications From the 11th June, all IMGs applying for their GMC Registration will need to have their primary medical qualification verified by the Educational Commission for Foreign Medical Graduates (ECFMG). In this article, we want to share some top tips on verifying your medical qualifications and hopefully make the process that little bit easier for you. Check the criteria Before sending your qualification off to ECFMG it is important to check that your primary medical qualification is on the list of acceptable overseas medical qualifications. If your qualification is not listed, you will need to contact the GMC for further advice. Please note that verification is also required if you are applying for registration through the approved postgraduate qualification route (rather than the PLAB route). In this case, you will need to verify both your primary medical qualification and your postgraduate qualification. Start the verification process as early as possible When you request for your qualification to be verified, ECFMG will contact the organisation which gave you your medical qualification (e.g. a medical school or a Royal College) and ask them to confirm that your qualification is genuine. The GMC can only keep applications open for 90 days, so it is a good idea to make the verification of your qualifications one of the first steps you take to prepare to work in the UK as the verification process can be lengthy. You can start the verification process as far in advance as financially possible, for example before taking PLAB Part 1. For guidance on how to set up an EPIC account please click here. In most instances, you will only need to have your primary medical qualification and postgraduate qualification verified Most doctors worry that they will now need to have all their documents verified, for example, an internship certificate – however, this is not the case. It is only your primary medical qualification and postgraduate qualification that will need to be verified. Advantages to verification The first advantage is that once you have had your qualification verified by ECFMG, the check will last for your entire career. Therefore, if you decided to work in another country where this is required, you would not need to have this verified again. Other countries that require this are Australia, the USA, Canada and the Republic of Ireland. Second, your EPIC account allows you to build an online portfolio of your medical qualifications, which you can update as you progress throughout your career. The third advantage of verification is that if you are re-applying for GMC Registration, you will not need to have your qualifications verified again. You will simply need to enter your existing EPIC ID number in your GMC application and use EPIC to send a verification report to them. Other registration requirements remain unchanged The registration process for IMGs has not changed. You will still need to: Evidence your English language skills - via IELTS or OET Attend an ID check at the GMC Offices – either London or Manchester Provide the GMC with evidence of good standing, where required Overall, the introduction of the verification from ECFMG simply confirms to the GMC that your qualifications are genuine. If you have a query about the verification process or GMC Registration, then email your question to and we will be happy to help you. And if you are an IMG who is ready to relocate to the UK and work within the NHS send your CV to and one of our Specialist Advisers will be in touch. Join our Facebook Group IMG Advisor – here you will have access to frequent blog posts on relocating to the UK and working within the NHS, the opportunity to ask questions and receive professional guidance and the chance to meet other IMGs. References Amison, R. (2018). 10 things you need to know about verifying your medical qualifications. [online] Medical professionalism and regulation in the UK. Available at: [Accessed 5 Sep. 2018].

Overview of FRCA

By Gabrielle Richardson
September 04, 2018

To become a Fellow of the Royal College of Anaesthetists by examination, you must pass: The Primary Exam Multiple-Choice-Question Paper OSCE and SOE The Final Exam Multiple-Choice-Question Paper Short-Answer-Question Exam SOE Those who pass the above exams will then be able to use the letters FRCA (Fellowship of the Royal College of Anaesthetists) after their name, as long as you are a Fellow or Member of the College. Exam Fees Primary MCQ £325 Primary OSCE & SOE £600 Primary OSCE £330 Primary SOE £300 Final Written Exam £480 Final SOE £565 Primary FRCA This part of the exam is broken into two sections (taken separately) Multiple Choice Question (MCQ) The Objective Structured Clinical Examination (OCSE) and Structure Oral Examination (SOE) Please note that you must pass the Primary FRCA MCQ before you can apply to sit the OSCE/SOE. The MCQ has a three-year validity. You must then pass the Primary Exam before applying for the Final FRCA. A pass in the Primary FRCA is valid for seven years as part eligibility towards the Final FRCA. Multiple-Choice-Question Exam Format Structure of the Exam The Primary MCQ consists of 90 multiple-choice-questions (60 x Multiple True False and 30 Single Best Answers in three hours). 20 MTF question in pharmacology 20 MTF questions in physiology, including related biochemistry and anatomy 20 questions in physics, clinical measurement and data interpretation 30 SBA questions in any of the categories listed above The exam is held three times a year in March, September and November. The exam is held at several venues across the UK in London, Birmingham, Sheffield, Manchester, Cardiff, Edinburgh and Belfast. The Objective Structured Clinical Examination (OCS) and Structure Oral Examination Please note that the FRCA OSCE and SOE must be taken together at the first attempt. If one component is failed only that component must be retaken. If you fail both sections, then you must retake them together. Purpose of the Exam The Primary OSCE and SOE examinations are blueprinted to the Basic Level Curriculum. The OSCE examination tests skills (both procedural and cognitive) which are underpinned by knowledge. The SOE tests your depth of knowledge and understanding of mechanisms and relevance. These exams will take place at the Royal College, Churchill House, 35 Red Lion Square, London WC1R 4SG. Structure of the OSCE Exam During this part of the exam, there will be 18 stations in one hour and 48 minutes. Of which 16 stations will count towards your result. Currently, the stations comprise of: Resuscitation Technical Skills Anatomy (General) History-taking Physical Examination Communication Skills Anaesthetic Hazards Interpretation of x-rays Structure of the SOE Exam There are two sub-sections to the SOE section comprising: 30-minutes; consisting of three-questions in pharmacology and three-questions in physiology and biochemistry; followed by 30-minutes consisting of three-questions in physics, clinical measurement, equipment and safety and three-questions on clinical topics (including a critical incident). Final FRCA This part of the exam has two sections (taken separately) Final Written exam consisting of MCQ and a Short Answer Question (SAQ) exam The Structure Oral Examination (SOE) Please note you must pass the Primary FRCA before you can apply for the Final FRCA. You must also pass the Final Written component before you apply for the SOE. The Final Written exam has a three-year validity. Purpose of the Exam The Final Written Examination is a stand-alone exam, applied for separately from the Final SOE Examination. The aim of the MCQ is to test your factual knowledge. The SAQ aims to test your higher thinking including judgement, ability to prioritise and summarise, and capability to present an argument clearly and succinctly in writing. Structure of the Exam Multiple Choice Questions (MCQs) 90 MCQ Examinations (60 x Multiple True False and 30 Single-Best-Answers in three-hours) Short-Answer-Questions (SAQs) 12 compulsory questions in three-hours normally comprising of: Six questions from mandatory units: Anaesthetic practice relevant to neurosurgery, neuroradiology and neuro-critical care, cardiothoracic surgery, intensive care medicine, obstetrics, paediatrics and pain medicine. Six questions from the remaining part of the curriculum. This includes general duties (airway management, day surgery, critical care incidents, general/urology/gynaecology surgery, ENT/maxilla-facial/dental surgery, management of respiratory and cardiac arrest, non-theatre duties, orthopaedic surgery, regional anaesthesia, sedation practice, transfer medicine, trauma and stabilization practice) optional units (ophthalmic surgery, plastics and burns surgery, vascular surgery), advanced sciences (anatomy, applied clinical pharmacology, applied physiology/biochemistry, physics/clinical measurement and statistical basis of clinical trial management) and professionalism in medical practice. There will be a maximum of one question from the optional units. The written exam is held twice a year in September and March and is held at several venues across the UK. Currently: London, Birmingham, Manchester, Sheffield, Cardiff, Edinburgh and Belfast. The Structure Oral Examination (SOE) The purpose The Final SOE comprises of two sections: Clinical short cases with linked clinical science questions Clinical anaesthesia (long and short cases) The aim of the clinical parts of the exam is to allow you to complement the Written Based Answers and examine the understanding and theoretical application of knowledge in clinical practice. Please note you must pass the Final Written Examination (in the preceding three-years) is required before you can sit the SOE. Link to example SOE Questions. Our guide to passing FRCA The fundamental reason people fail their FRCA exams is the lack of preparation. In this section of the blog, we aim to provide you with guidance on how to successfully pass your exams. Plan plan plan – This planning period involves both mental preparation and physical preparation. Revising for your exams will take up a lot of your time and energy and so it is important to get organised in order to motivate yourself for an exam in six months’ times. Finances – It is important to calculate how much taking the FRCR exams is going to cost you. These financial factors include the cost of books, courses (with concurrent travel and accommodation), the exam fees, and accommodation and travel to London or other UK cities for the exam. Syllabus – The Royal College has revealed that candidates who fail their exams is a result of poor study technique, particularly an ability in following the syllabus when structuring their revision. So, our advice to you is to use the syllabus for the exam and create a road-map ticking off each section of the revision when you have completed it. Courses – Some candidates enjoy partaking in a revision course. Courses are beneficial because they allow you to apply your knowledge to medical practise whilst providing you with valuable teaching and experience which cannot be gained from revising from books. Please click here for a list of available courses. Books – Some books are fundamental to passing FRCA, and some others are available that are a personal choice depending on your learning style. The best place to start is to look at the Anaesthesia UK recommended Primary FRCA Book List. Second, is the Royal College’s Resources list. Study leave – If you are planning on attending a revision course, you will need to check with your department how much study leave you qualify for prior to booking and do not forget to factor in the exam periods. We would like to wish anyone who is sitting their FRCA exams a big good luck! And if you are a doctor who has recently obtained your fellowship of the Royal College of Anaesthetists then send your CV to and one of our Specialist Advisers will be in touch. Come and join our Facebook Group IMG Advisor! Here you will have frequent access to our relocation blog posts, the opportunity to ask questions and receive professional answers and to meet other IMGs! References (2018). Primary FRCA MCQ | The Royal College of Anaesthetists. [online] Available at: [Accessed 3 Sep. 2018]. (2018). Primary FRCA OSCE/SOE | The Royal College of Anaesthetists. [online] Available at: [Accessed 3 Sep. 2018]. (2018). Final FRCA Written | The Royal College of Anaesthetists. [online] Available at: [Accessed 3 Sep. 2018]. (2018). Final FRCA SOE | The Royal College of Anaesthetists. [online] Available at: [Accessed 3 Sep. 2018].

Additional PAs

By Gabrielle Richardson
August 31, 2018

Introduction When applying for your first NHS post, you should always try and make sure you have a job description and as much detail about the post and Trust prior to interviewing. However, during your interview is always a great time to ask for further information such as proposed objectives, supporting resources available to allow you to carry out your work – all information which will show you are interested in the position. Please note that prior to starting your position you may be given an idea of your working rota, however, the likelihood is that your rota will change slightly once you arrive at the Trust. My contract is based on PAs, what are they? PAs stand for ‘Programmed Activities’. A PA is 4 hours of work if done within the normal working week (Monday to Friday 8am-8pm). A PA done outside of the normal working week is 3 hours of work. All the activities in your job must be detailed in your job plan – and it is important to agree to the content of the job plan before taking up your post. How many PAs should be in my contract? The standard full-time contract is for 10 PAs, i.e. 40 hours of work per week (if that work is within the normal working week). Posts that are less than full-time will be for fewer than 10 PAs. However, some posts may advertise for more than 10 PAs, generally 11 or 12, (PAs greater than 12 would necessitate the doctor to opt out of the European Working Time Directive limit of 48). Types of PAs Direct Clinical Care – work directly on patient care, includes ward rounds, theatre sessions, all administration connected with name patients Supporting Professional Activities – work underpinning patient care including teaching, audit, appraisal, research, training, clinical governance and clinical management Additional NHS Responsibilities – sitting on appointment or disciplinary panels, CEA panels, not necessarily for own employer but for benefit of NHS, Caldicott Guardian or Guardian of Hours Other / External Duties – Senior positions in Royal Colleges, BMA, GMC, DH working parties or negotiating groups Do I have to work more than 10 PAs? No, you do not. You are not obliged (or entitled) to undertake any more than 10PAs per week. As a new full-time Speciality Doctor or Consultant, you should be offered a 10 PA contract, and your job plan should clearly state the work to be undertaken in each PA. However, where it is not possible for your department to maintain their service, then you may, at the discretion of your employer, be offered more than 10 PAs (and the post may have been advertised as such – see above). Are PAs over 10 ‘special’ in any way? PAs over 10 are called EPAs (extra programmed activities) and these are generally allocated for clinical duties. EPAs must be contracted separately to your standard contract and the duties within the 11th or 12th PA should be clearly specified. Can my employer demand that I work some of my PAs outside the normal working week? Your hospital cannot require you to undertake scheduled work outside of 8am to 8pm Monday to Friday, 9am to 1pm on Saturdays or on public holidays. Any PA undertaken outside of the hours 8am to 8pm Monday to Friday is regarded as taking place in ‘premium time’. This means that the PA must last 3 hours instead of 4. Your contract should state that no more than 3 PAs per week should be out of hours other than in exceptional circumstances. Please note that the definition of premium time does not mean that, Monday to Friday, has been designated as the ‘normal working week’. It simply sets a higher rate of pay for work outside of these hours. How will my on-call duties be calculated? Your on-call commitment should be clearly set out in your job plan. Types of on-call: Working out of hours: Some specialities (including anaesthetics, surgery, obstetrics), schedule out of hour PAs, where a Speciality Doctor or Consultant is mostly “hands-on” working and some rotas are now based on this working pattern. Your job plan must be structured to ensure adequate rest is provided before and after the hours period. Remember, that the number of PAs undertaken during the out of hours period should not exceed 3 per week other than in exceptional circumstances. On-call rota: Participating in an on-call rota is recognised through the payment of an availability supplement representing a percentage of basic salary which reflects the frequency and level of availability. This supplement is separate from the actual work undertaken when you are on-call, which is recognised and paid through the PA allocation. I am still not sure about my contract and the job plan I am being offered: what should I do? The fundamental thing to do in this situation is to get advice Contact your Recruitment Consultant – they will be able to liaise between you and your HR department to provide clarification and a solution. Contact the BMA – if you are a BMA member you can phone the BMA for employment advice on 0300 123 1233 or email If you are an international doctor who wants to relocate to the UK and work within the NHS, please send your CV to and one of our Specialist Advisers will be in touch. Join our Facebook Group IMG Advisor – here you will have access to frequent blog posts, the opportunity to ask questions regarding relocating to the UK and working within the NHS with professional answers and the chance to meet others IMGs! References JOB PLANNING FOR YOUR FIRST CONSULTANT POST. (2014). British Medical Association.

Voicing your concerns within the NHS

By Gabrielle Richardson
August 30, 2018

As an employee of a large organisation, you may at some point in your career encounter some worries or stresses with other members of staff, perhaps with the way they speak to you or you may disagree with their medical practices. This can lead to you feeling lonely or stressful. So, in today’s article, we outline the different options available to you which will let you voice your concerns. Speak to your recruitment agent Speak to your line manager Raise your concern with your Trusts National Guardian Contact other independent bodies Speak to your recruitment agent If you are experiencing some troubles at work, and you can contact your recruitment agent who helped you find your position, then please inform them first. We understand that approaching your line manager or HR department may be an awkward task for you. Therefore, we would happily speak to them on behalf of you, raise your concerns and will then help find a solution to your problem. However, if you applied directly via NHS jobs then you will have to follow the below steps: Speak to your line manager If you are experiencing worries at work the first piece of advice to you is to contact your line manager. It is important to do this in the first instance before the problem escalates and worsens. Your line manager will listen to your concerns and see if they can help you solve the issue, and in most cases, they will. However, if your manager feels it is outside of their realm of work then they may ask you to speak to the HR department. Once you have raised your concerns with your HR department they will refer to their grievance policy and follow the procedure to help solve your concerns. If it is another member of staff you are having an issue with, then typically, they will organise an informal meeting with the both of you to sit down, speak about your differences and you will leave the meeting with a solution. If, however, your concern is larger and refers to needing to protect your rights then the HR department will follow an alternative procedure. These characteristics include: Age Disability Gender reassignment Marriage and civil partnership Pregnancy and maternity Race Religion or belief Sex Sexual Orientation Raise your concern with your Trusts National Guardian If your concerns are unable to be solved with your line manager or the HR department, or you feel that the outcome of meetings are unfair, and you are still unhappy then you may want to raise your troubles with the National Guardian. What is the National Guardian? Following a Public Inquiry at Mid Staffordshire NHS Foundation Trust the Francis Report revealed that NHS employees had tried to speak up about patient safety concerns but had been ignored. In the succeeding Freedom to Speak Up Report, Sir Robert Francis made recommendations for the changes needed to improve the NHS, leading to an open and transparent culture for the benefit of patient care. The question raised was – who do you turn to if you want to speak up? Its purpose – to protect you as an individual   It can often be challenging for new employees to speak up, especially those who are from another country and are new to the NHS system and this can leave staff feeling vulnerable about being offered work or having their training signed off. So, the purpose of the independent body is to allow NHS employees who are having troubles with their professional relationships, worries about their future employment and any concerns over patient safety, probity or conduct concern. National Guardian’s Office For this reason, the National Guardian’s Office was set up as a key recommendation of the Francis Report to support NHS employees who want to speak up. The overarching principle is that every organisation needs to foster a culture of safety in which all workers feel safe to raise a concern. In March 2017, all NHS Trusts had appointed either a single or multiple individuals to the role. Remember, that before approaching your Trust’s National Guardian appointee, it is important that you have approached your line manager and your HR department. Contacting other independent bodies If you feel that patient safety, dignity or comfort is being comprised you can also contact other independent bodies such as: The General Medicine Council British Doctors Association If you are an IMG who is interested in relocating to the UK and working within the NHS send your CV to and one of our Specialist Advisers will be in touch. Join our Facebook Group IMG Advisor! If you would like to have access to frequent blog posts, the opportunity to ask relocation questions and receive professional answers and meet other IMGs then come and join our big IMG community.

Interview with Naseer Khan, writer of "Naseer's Journey"

By Gabrielle Richardson
August 30, 2018

Introduction I would like to thank BDI Resourcing for organising this interview, it is an honour for me to be interviewed by them. I would like to start by saying that BDI Resourcing has done some amazing work by creating their blog aimed at helping international doctors relocate to the UK and work within the NHS. I know how difficult it is to create a blog and the amount of dedication it requires. They, therefore, deserve a lot of credit for this reason. I am sure that countless doctors are getting guidance from their blog. What speciality of medicine do you work in and at what hospital? I currently work as an SHO at a rotational post in General Medicine at King’s College Hospital, London. So far, I have worked in the following departments: Stroke, Neurology, AMU, Geriatrics and Frailty. Before this, I worked for 6 months in Renal Medicine and Transplant Surgery at Queen Alexandra Hospital in Portsmouth. Would you share with us your personal mission as a doctor? My dream is to see a top quality and free healthcare system in Pakistan. I would like to take my experiences gained from working within the NHS and help with the development of a similar system in Pakistan. But I do want to take it one step at a time. For now, I wish to move forward in my career, whilst helping my colleagues and juniors. At what point in your career did you decide that you wanted to relocate to the UK? And what were your motivations for wanting to do so? During my time at medical school, my aim was to attempt the USMLE and relocate to the United States. However, I always felt that it was a very difficult exam and I was unsure I would have been able to pass it. I attended a career guidance seminar at Aga Khan University, Karachi in January 2014 and the seminar convinced me to sit the PLAB exams and relocate to the United Kingdom instead. I chose the PLAB route into the NHS because I found it to be the shortest, easiest, least expensive and the most convenient pathway. For you, what are the key benefits of living in the UK? There are many advantages to living in the UK, but here are the most important ones to me: A quick start: PLAB is an easy exam and it does not take much time Quality earnings: The starting salary for a doctor is the same in the UK as it is in the USA, making the decision to relocate to the UK a lot easier The UK is a welfare state It is fascinating to see how a free healthcare system function’s As a doctor in the UK, you will be in a position to make a difference You will have the freedom to do whatever you like British people are incredibly nice and friendly You will have enough finances to buy any car in the world As a junior doctor, you will earn enough to buy your own house How long did it take you to relocate, how difficult was the process and do you recommend it to others? I decided to sit PLAB in January 2014 and I started working in the UK in August 2017, taking me three years. In fact, I should have started working in the UK in August 2015. However, I had to wait two years because of the CoS and visa rejections. The rejections myself and many other doctors faced hurt me deeply and caused a significant amount of depression for me. But I learnt a lot from the experience. If it had not been for the visa rejections I would never have made my blog to help guide doctors to the UK on such a large scale. I am blessed to be working in the UK and I cannot thank my parents and Dr Hamed Salehi enough for making this possible for me. With regards to recommending others, I want people to know that the NHS has more jobs than ever before. The NHS is severely short of doctors and Brexit will create even more jobs for international doctors because we will be in the same boat as EEA citizens. Please note that PLAB is a very easy exam – do not be afraid to sit it. We are blessed that there is so much guidance available online for doctors who wish to work in the UK. No other route has this amount of guidance and support available. Having said this, people should weigh up the pros and cons of each route in the NHS and make their own decisions. Is there anything you would have liked to have known before deciding to relocate? And now once you are living in the UK? I cannot think of anything specific that people should know before coming to the UK. What I am grateful for is how nice people were to me on Facebook. Facebook was an excellent tool for building connections with people even before coming to the UK. When I arrived in the UK, I did, however, know a lot of people who I learnt the basics about working within the NHS. These people were not active on Facebook and they learnt things the hard way. My advice to doctors who wish to come to the UK is to join all the relevant Facebook groups and to keep their eyes and ears open to any advice doctors are offering. How long did it take you to settle into the UK? My first job in the UK was in Cosham, Portsmouth. It is a very nice, clean, green, quiet, small, wet and rainy town on the south coast of the UK. I decided to live in hospital accommodation, which was only thirty seconds from the hospital entrance. The food market and the nearest train station were only five minutes away from the hospital. I did not mind the fact that Cosham was a small and quiet place. I know this may surprise a lot of people, but I am a very shy and quiet person; I am an introvert. So, I was very happy in Portsmouth. However, I must admit that I found the love of my life who lived in London. Therefore, after spending six months in Portsmouth, I decided to move to the UK’s capital. I was very happy and excited to move to London as it is the best city in the world. All your dreams can be made true in London. The only downside to life in London is the expensive property rents. I live near King’s College Hospital, which is a very expensive area to live in. However, I must confess that I have easily saved the same amount of money as I was saving in Portsmouth. So, living in London is not only possible but you can even save money whilst living here. It all depends on how good you are at saving your finances. But as much as I confessed earlier, I am a shy, quiet and private person so I do not go out much. As much as I love London, long-term, I don’t think the lifestyle is for me. So, I will try and get my training outside of the city. How would you describe the support you received from your hospital after starting your new position? I love the people in the UK. The HR at King’s were extremely supportive towards me. They helped me with documentation, they also kindly arranged a two-week paid observership period for me. The Consultants were also extremely nice to me, they were willing to give me the margin to learn and adapt to the system. Most of the registrars and SHOs were also very helpful and supportive. Having said this, the first few weeks or months at your first job in the UK are bound to be difficult. It takes time to adjust and so you should be prepared for things to be tough at first. Whenever you change jobs, you will again have to adapt to a new system. Therefore, it is ideal to stay at the same job until you find training. On reflection, what I did by switching jobs was not ideal. But well, I wanted to get married and start a new life. So, I am very happy with my decision to move to London. What are your views on the NHS as a system? Working within it and as a patient who receives care? The NHS provides free healthcare to people regardless of their age, gender, ethnicity or financial background. The system is designed on the basis of humanity. There is nothing more beautiful than this. For me, it is an honour and a privilege to be part of this system. When I fractured my finger last year, I became a patient of the NHS. I was treated for free. I was also given paid sick leave to cover my period of illness. I could not have asked for better care. How do you find working in the UK compared to your home country? Working in the UK is completely different from working in Pakistan. There is a lot I can say here, but to keep it simple, there are two main differences between working in the UK and Pakistan: In Pakistan, doctors are underpaid. In the UK we are given our fair share. In the UK, making a mistake can be costly because of the lawsuits. Therefore, we must be more cautious and careful while working. What are your hopes for the future? My hopes for the NHS: The NHS has changed the way that I look at healthcare. I have nothing but respect for the healthcare system in the UK. I wish to see the NHS saving more and more lives and making more and more people’s lives better. My hopes for my country’s healthcare system: I wish to see a similar system in Pakistan. My hopes for myself: I wish to become a GP and to make a positive influence and difference in as many people’s lives as I can. Conclusion Thank you so much for taking the time for reading this interview. I would like to wish the best of luck to BDI Resourcing and I hope they can keep helping doctors as much as they can.

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